Symblepharon is an eye condition where the conjunctiva, the transparent membrane lining the inner surface of the eyelids and covering the white part of the eyeball, abnormally adheres to itself or to the cornea. This adhesion forms a web-like connection that can restrict eye movement and cause discomfort. It typically arises from scarring and inflammation after ocular injury or disease.
Understanding Symblepharon
Symblepharon involves the abnormal fusion of the palpebral conjunctiva (lining the eyelids) and the bulbar conjunctiva (covering the eyeball). This adhesion forms during an abnormal healing process after conjunctival injury, where a loss of epithelial cells allows surfaces to stick together. Severe inflammation can cause tissues to swell, adhere, and form scars, permanently fusing these layers.
The condition is classified by its extent and location. Simple symblepharon involves small adhesions. More extensive adhesions characterize cicatricial symblepharon, often from significant inflammation and scarring.
Fornix symblepharon refers to adhesions in the conjunctival fornices, the natural recesses between the eyeball and eyelids. Symblepharon can also be partial, covering a portion of the conjunctival surface, or total, covering the entire eye, which is the most severe form.
Common Causes and Indicators
Symblepharon frequently develops due to trauma or inflammatory eye conditions. Chemical burns, especially from alkali substances, and thermal burns are common causes, as they damage the conjunctiva, leading to inflammation and tissue loss that results in fibrous adhesions. Severe ocular infections, such as chronic chlamydial eye infections, trachoma, and epidemic keratoconjunctivitis, also cause conjunctival inflammation and scarring. Physical trauma to the eye can create open conjunctival wounds that may heal together if not properly managed.
Autoimmune conditions are also associated with symblepharon, including Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis and ocular cicatricial pemphigoid. These diseases cause conjunctival inflammation, injuring the epithelium and leading to adhesion. Individuals with symblepharon may experience reduced eye movement, discomfort, and irritation. Other indicators include dry eye symptoms, light sensitivity, blurred vision, double vision (diplopia), or cosmetic concerns due to visible tissue bands connecting the eyelid to the eyeball. In severe instances, damage to the conjunctival fornix can lead to insufficient tear retention and potential keratinization of the ocular surface.
Path to Diagnosis and Management
An eye care professional diagnoses symblepharon through a comprehensive eye examination. This examination often includes a slit-lamp examination for detailed visualization of the conjunctiva and any adhesions. Fluorescein staining may be used to identify areas of damage. If the underlying cause is unknown, an eye swab or blood test may be suggested to identify infections or autoimmune conditions.
Management and treatment approaches vary depending on the severity and underlying cause of the symblepharon. Non-surgical methods aim to alleviate symptoms and prevent further adhesion. These can include the use of lubricating eye drops and ointments to reduce dryness and friction, and anti-inflammatory eye drops, such as corticosteroids, to control inflammation. Immunomodulators or immunosuppressive drugs may be prescribed for cases linked to autoimmune conditions to adjust the immune response and lessen inflammation.
Surgical interventions are often necessary for more severe cases to release adhesions and restore normal eye function. Symblepharon lysis involves surgically disconnecting the adhesions between the conjunctiva layers, sometimes requiring the removal of scar tissue.
Tissue grafting procedures, such as amniotic membrane transplantation, are commonly employed to promote healing and reduce scarring, providing a scaffold for epithelialization. Other grafting options include conjunctival autografting (using tissue from another part of the patient’s own eye) or mucous membrane grafts, often taken from the inside of the lip or nasal mucosa, to replace damaged tissue. Cultivated limbal stem cell transplantation may be considered for severe burns, but it is typically performed when active inflammation has subsided. The overall goals of treatment involve restoring ocular motility, improving vision, and preventing recurrence.
Preventive Measures and Outlook
Preventive measures for symblepharon largely focus on the immediate and proper management of eye injuries and inflammatory conditions. For instance, thorough irrigation is recommended for chemical burns to minimize damage and reduce the risk of adhesion formation. Prompt treatment of eye infections and effective management of any underlying inflammatory or autoimmune conditions are also important to prevent scarring of the conjunctiva. Seeking timely medical attention for any severe eye trauma, burns, or persistent inflammation can help minimize scarring and reduce the risk of symblepharon development.
The outlook for individuals with symblepharon varies, depending on factors such as the underlying cause, the extent of adhesions, and the timeliness and effectiveness of treatment. Mild cases with limited adhesions may have a more favorable prognosis, while severe cases covering a larger area of the eye can present greater challenges. Early detection and intervention generally contribute to better outcomes. While some severe cases may lead to permanent vision impairment, significant improvements are often possible with appropriate medical and surgical care.